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In the recent article by Zamir et al entitled, “Self-inflicted Anterior Scleritis,”1Zamir E. Read R.W. Rao N.A. Self-inflicted anterior scleritis.Ophthalmology. 2001; 108: 192-195Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar self-inflicted illnesses can certainly be difficult to sort out at times.2Jordan D.R. Nerad J. Tse D. An unusual case of orbital cellulitis.Can J Ophthalmol. 1990; 25 ([review]): 210-212PubMed Google Scholar There are two terms introduced in the article, “malingering and factitious disorder,” that require clarification. I have concerns with the authors’ statement that the term factitious disorder “is also used in a broader sense to describe self-inflicted conditions produced by a deceptive patient to gain financial or other secondary gains (malingering).” This is confusing to the readership.The Diagnostic and Statistical Manual of Mental Disorders describes a factitious disorder as characterized by physical or psychologic symptoms that are intentionally produced or feigned to assume the sick role.3Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed. Washington DC: American Psychiatric Association 1994;471–5, 683.Google Scholar The motivation is a psychologic need to assume the sick role, as evidenced by an absence of external incentives for the behavior.3Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed. Washington DC: American Psychiatric Association 1994;471–5, 683.Google Scholar Factitious disorders are distinguished from acts of malingering.3Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed. Washington DC: American Psychiatric Association 1994;471–5, 683.Google Scholar In malingering, the individual also produces the symptoms intentionally but has an external incentive for the behavior (economic gain, avoiding work, avoiding military duty, etc.).3Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed. Washington DC: American Psychiatric Association 1994;471–5, 683.Google ScholarThus, malingering differs from factitious disorder in that the motivation for the symptom production in malingering is an external incentive, whereas in factitious disorder, external incentives are absent.The authors’ case 1 clearly had an external incentive present (disability pension) and should therefore be classified as an act of malingering. Case 2 has no obvious external incentive and therefore represents a factitious disorder. Both, however, have “self-inflicted” diseases. In the recent article by Zamir et al entitled, “Self-inflicted Anterior Scleritis,”1Zamir E. Read R.W. Rao N.A. Self-inflicted anterior scleritis.Ophthalmology. 2001; 108: 192-195Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar self-inflicted illnesses can certainly be difficult to sort out at times.2Jordan D.R. Nerad J. Tse D. An unusual case of orbital cellulitis.Can J Ophthalmol. 1990; 25 ([review]): 210-212PubMed Google Scholar There are two terms introduced in the article, “malingering and factitious disorder,” that require clarification. I have concerns with the authors’ statement that the term factitious disorder “is also used in a broader sense to describe self-inflicted conditions produced by a deceptive patient to gain financial or other secondary gains (malingering).” This is confusing to the readership. The Diagnostic and Statistical Manual of Mental Disorders describes a factitious disorder as characterized by physical or psychologic symptoms that are intentionally produced or feigned to assume the sick role.3Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed. Washington DC: American Psychiatric Association 1994;471–5, 683.Google Scholar The motivation is a psychologic need to assume the sick role, as evidenced by an absence of external incentives for the behavior.3Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed. Washington DC: American Psychiatric Association 1994;471–5, 683.Google Scholar Factitious disorders are distinguished from acts of malingering.3Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed. Washington DC: American Psychiatric Association 1994;471–5, 683.Google Scholar In malingering, the individual also produces the symptoms intentionally but has an external incentive for the behavior (economic gain, avoiding work, avoiding military duty, etc.).3Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed. Washington DC: American Psychiatric Association 1994;471–5, 683.Google Scholar Thus, malingering differs from factitious disorder in that the motivation for the symptom production in malingering is an external incentive, whereas in factitious disorder, external incentives are absent. The authors’ case 1 clearly had an external incentive present (disability pension) and should therefore be classified as an act of malingering. Case 2 has no obvious external incentive and therefore represents a factitious disorder. Both, however, have “self-inflicted” diseases. Cut and paste: Author replyOphthalmologyVol. 108Issue 11Preview Full-Text PDF